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Difficulty: HardReduction of Risk Potential

A practical nurse (PN) is contributing to the care of a client who is 4 hours postoperative following a total thyroidectomy. Which interventions should the PN implement to reduce the client's risk for postoperative complications? (Select all that apply.)

  1. Keep an emergency tracheostomy tray and functioning suction equipment readily available at the bedside.Answer
  2. Assess the surgical dressing and the back of the client's neck for dependent pooling of blood.Answer
  3. Monitor for the presence of a positive Trousseau's sign or Chvostek's sign during routine data collection.Answer
  4. D
    Maintain the client in a flat, supine position to minimize tension on the cervical suture line.
  5. E
    Administer the prescribed intravenous push (IVP) morphine sulfate to manage severe incisional pain.
  6. F
    Escalate to the registered nurse immediately if the client's serum total calcium level is reported as 9.4 mg/dL (2.35 mmol/L).

Answer

The correct interventions are to keep an emergency tracheostomy tray and suction equipment at the bedside, assess the back of the neck for dependent bleeding, and monitor for Trousseau's or Chvostek's signs.
The correct actions directly address the three most critical complications of a thyroidectomy. Maintaining airway equipment at the bedside prepares the care team for acute respiratory distress caused by swelling, hematoma, or laryngeal nerve damage. Checking the back of the neck ensures dependent hemorrhage is not missed, as blood often drains posteriorly via gravity. Monitoring for Trousseau's or Chvostek's signs allows for early clinical detection of hypocalcemia, which frequently occurs if the parathyroid glands were disturbed or removed during surgery.

Step-by-Step Solution

1
Analyze the specific risks associated with a total thyroidectomy.
The primary life-threatening risks include airway compromise (from edema or hematoma), hemorrhage, and hypocalcemia (due to inadvertent damage to the parathyroid glands).
Identifying the target complications directs the nurse toward the correct preventative and monitoring interventions.
2
Evaluate the preventive interventions that directly mitigate these risks.
Emergency airway equipment prepares for respiratory distress, checking the posterior neck detects hidden hemorrhage, and assessing for tetany (Trousseau's/Chvostek's) identifies early hypocalcemia.
These actions are evidence-based, within the PN scope of practice, and directly address the identified high-risk complications.
3
Differentiate expected care and scope boundaries from the incorrect options.
Placing the client flat is dangerous (increases edema). IV push analgesics are outside the standard PN scope. A calcium level of 9.4 mg/dL is a normal finding, not a crisis.
Eliminating incorrect actions requires combining knowledge of safe positioning, legal scope of practice, and normal laboratory thresholds.

Key Concept

Postoperative Thyroidectomy Complications and Scope of Practice
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Topics

Reduction of Risk Potential

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